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RC-14-1943Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-221461 Permit Number: RC -9-14-1943 Scheduled Inspection Date: October 14, 2014 Inspector: Rodriguez, Jorge Owner: WILLIAMS, PAMELA Job Address: 68 NW 93 Street Miami Shores, FL Project: <NONE> Permit Type: Residential Construction Inspection Type: Final Building Work Classification: Alteration Phone Number Parcel Number 1131010170030 Contractor: STATEWIDE BUILDING CONTRACTORS Phone: (305)219-4952 Ismiaing uepartment comments REPLACE EXISTING KITCHEN CABINETS AND REPLACEI Infractio Passed Comments FRONT DOOR INSPECTOR COMMENTS False October 10, 2014 For Inspections please call: (305)762-4949 Page 20 of 24 Inspector Comments Passed Failed Correction Needed ❑ Re -inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. October 10, 2014 For Inspections please call: (305)762-4949 Page 20 of 24 a BUILDING Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 PERMIT APPLICATION BUILDING r-1ELECTRIC❑ ROOFING t 89P 14 FBC 20 "-� Master Permit No. 1� u q —' ri-k-1 Sub Permit No. ❑ REVISION ❑ EXTENSION ❑ RENEWAL PLUMBING ❑ MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: C1 R kk G 3 57 City: Miami Shores County: Miami Dade Zip: r7 % f Folio/Parcel#: 11 - 3 to 0 006 Is the Building Historically Designated: Yes NO 'C Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): � �( �'( ° r Phone#: Address: 1 (3 ® 60110104 Fklh5 pAw y R41- City: Coto avor State: TAI Zip: 3ci�01� Tenant/Lessee Name: Phone#: Email: CONTRACTOR:, Company Name: SlIAkW le 8141 IA' �s Phone#: 30r alci41 S'�o Address: 6 o S\, 16 3 P 1, City: dYi)&M" State: I✓L Zip: 3)53 Qualifier Name: bane) 6,q -w Phone#: 37d/0,49Sd State Certification or Registration #: c 6 C 1 Sa CLI Certificate of Competency #: DESIGNER: Architect/Engineer: Address: / r v City: State: G Value of Work for this Permit: $ c2J Square/Linear dotage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New 21 Repair/Replace Zip: f e'Q- El Demolition Description of Work: f e Plc It R -A44" 45 C46' q4S , 9140,A) -"J f I(' dYi'0 1 T4 -C' pre MCI,' '15 ]C,�o,,,} k feM4Jn Specify color of color thru tile: Submittal Fee $ Permit Fee $ on 'kO CCF $ CO/CC $ Scanning Fee $ Radon Fee $ 33DBPR $ •3d Notary $ Technology Fee $ Training/Education Fee $t *TU Double Fee $�-� Structural Reviews$ TT Bond $ G PQM (T- : 4 ffWM' 00 TOTAL FEE NOW DUE $ (Revised02/24/2014) Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address Zip City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING; SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature � f�,nn"Q r+�.o Signature g g OWNER or AGENT The foregoing instrument was acknowledged before me this << day of J i , 20 14 by : yho is personal) own to me or who has produced identification and who did take an oath. i1611f_I;V721I3AEd; Sign: ----, aLourdes Made Gimet>ez n 20 Print: 's�' .F000i MAY30.2Qi7 W WJ"NNot4RKcom Seal: CONTRACTOR The foregoing instrument was acknowledged before me this day of �0� , 20 A , by C— "f/ 6 ; who is personal) wn to as me or who has produced identification and who did take an oath. NOTARY PUBLC: (� dpubi ypp'•. Lourdes Marie Gime nez Sign: MCNI NION#FF022820 —mm MAY 30,2017 Print: ° p��`•WWWARRONNOm. Seal: as 0 APPROVED -BY I Plans Examiner Zoning n Structural Review Clerk (RevisedO2/24/2014) FannieMae,, June 10, 2014 To: MIAMI SHORES BUILDING DEPARTMENT 10050 NE 2ND AVE MIAMI SHORES VILLAGE, FL 33138 Attn: This letter confirms that the below listed Company is employed as an approved Fannie Mae vendor and has our approval to sign for permits and record Notice of Commencements on behalf of Fannie Mae for the below listed property. Should you have any questions, you can contact us at dale^p_rich*fannismae.com. APPROVED FANNIE MAE AGENT: TR14046OX STATEWIDE BUILDING CONTRACTORS DAN I EL GATO FANNIE MAE PROPERTY ADDRESS: Al2ONVR 68 NW 93RD STREET MIAMI SHORES, FL 33150WCOMMMMOEB :17 Sincerely, Dale Phil Rich Fannie Mae I REO Sales Division Ft. Lauderdale _fid►'' ANA VAMUM The foregoing instruments acknowled ed Ernethnis d of � ( hY IPP (BI bre of Notary P C -Stan Florldaj (Pr t, Type, or 6tamp CoWnlooned Name of Notary Public)) Personally known -----)LX—OR Produced Identification Type of Idents mMon Produced Report Viewer JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW'" " CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 10x7/2014 EXPIRATION DATE: 10/6/2016 PERSON: GATO DANIEL FEIN: 800112265 BUSINESS NAME AND ADDRESS: STATEWIDE BUILDING CONTRACTORS LLC 6044 SW 163 PLACE MIAMI FL 33193 SCOPES OF BUSINESS OR TRADE: LICENSED GENERAL CONTRACTOR PurmraMto chapter 44U.i15(141 F.S., an officer of a corporation vdro elegy exempgan Gam Urs by a cer�cete of election under Urs n MY not recever benetils ar cempensation ur�derthie papier. PureueMto Ciucpter440A5(12), F -S-, of elan to be ermn�f._ apply may withlntlta scepe otUre business ortmde Usterl on Ure notice otelee6on to be exempt Pursuant to Chepter440.05tt13), F.S.. tdatices of e1�8cn to � exempt mid ceAfimtes of eEe�an to be exempt shall � subject to revoeauon U, et airy tinxi atter Ure of Ure notice ordre issuance of Bre eerUBcete, Ure person named on the noib w eendtcem iro longer rrteais ti>a requtrerratnLg oFUds see�ri for tewrartce of a cer7fimta. The departmm�t stiaU revoke a carUf�ate at any tirtm fortaiWre offlee person nm�red an Use cmUfiaate to maettite requ6errrerils otflda sactim. DFS -F2 DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS? (850)413-1609 RICK SCOTT, GOVERNOR DEPARTMENT OF Bl Pagel Of 2 KEN LAWSON, SECRETARY STATE OF FLORIDA CONSTRUCTION"INDUSTRI G TL?„DANIEL +� R STATEVE BUII.DIIQ ilii -1� k a z 0�4 SPIV 1 RO �,t ; «� 6 Pl �I1�AMI`r� US NZAr uh�M MoZ 'kRol zi"'�. ISSUED: 07/24/2014 DISPLAY AS REQUIRED BY LAVH SEQ# L1407240001247 002333 Local Business Tax Receipt Miami -Dade County, State of Florida —THIS IS NOT A BILL — DO NOT PAY 5422910 LBT BUSINESS NAMEULOCATION RECEIPT NO. EXPIRES STATEWIDE BUILDING CONTRACTOR LLC RENEWAL SEPTEMBER 30, 2014 14080 SW 38 ST 5662698 Must be displayed at place of business MIAMI FL 33175 Pursuant to County Code Chapter 8A — Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS STATEWIDE BUILDING CONTRACTOR 196 GENERAL BUILDING CONTRACTOR PAYMENT RECEIVED LLC CGC1507864 BY TAX COLLECTOR Worker(s) 1 $75.00 08/18/2013 CREDITCARD-13-005767 This Local Business Tau Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, permit, or a certification of the holders qualifications, to do business. Holder must comply with any govemmeMal or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT N0. above must be displayed on all commercial vehicles — Miami—Dade Code Sec 88-276. For more information, visit www miamidada go_vRaxcoiloctor MIAMFID D MIAMI-DADE COUNTY - STATE OF FLORIDA N/A October 01, 2014 MIAMFID:)ADD LOCAL BUSINESS TAX RENEWAL 5422910 2014 -2015 APPLICATION RECEIPT: 5662698 STATE # CGC1507864 DBA/BUSINESS NAME: BUS. COMMENCEMENT DATE: 10/01/2004 STATEWIDE BUILDING CONTRACTOR LLC SEC TYPE OF BUSINESS BUSINESS LOCATION: BLDG1 GENERAL BUILDING CONTRACTOR 14080 SW 38 ST 1 MIAMI, FL 33175 OWNERICORP. STATEWIDE BUILDING CONTRACTOR LLC PHONE # 305-219-4952 14080 SW 38 ST MIAMI, FL 33175 NAICS CODE: 2389 If no longer In business, please notify us In writing. Review and correct the information shown on this application. A 25% penalty will be assessed to anyone found operating without a paid local business tax, in addition to any other penalty provided by law or ordinance (Sec 8A-176(2)). A Certificate of Use and/or City Business Tax Receipt may also be required. APPLtCATION DETAILS FEE AMOUNT Receipt Fee 30.00 UMSA Fee 30.00 Beacon Council Fee 15.00 Bingo Permit Fee 0.00 Nightclub Permit Fee 0.00 Multi -Municipal Contractor Fee 0.00 Restricted Contractor Fee 0.00 Library Fee 0.00 Transfer Fee 0.00 Doing Business Without a License Penalty 0.00 Late Penalty 0.00 Collection Cost 0.00 NSF Fee 0.00 Prior Years Due 0.00 Amount Recently Paid - 75.00 TOTAL AMOUNT DUE: 0.00 To pay online go to www.miamidade.gov/taxcollector To pay by mail, make check payable to: Miami -Dade County Tax Collector Business Tax 200 NW 2nd Avenue Miami FL 33128 To pay in person go to: 200 NW 2nd Avenue (305) 270-4949, fax (305) 372-6368 A service fee of not less than $25.00 up to a minimum of 5% will be charged for all returned checks. t RETAIN FOR YOUR RECORDS t ................................................................................................................................................................................................................................................................................................................. MIAMI-DADE COUNTY - DETACH HERE AND RETURN THIS PORTION WITH YOUR PAYMENT + N/A October 01, 2014 STATE OF FLORIDA LOCAL BUSINESS TAX RENEWAL RECEIPM 5662698 2014 -2015 APPLICATION �lu�ll�ll�lll�ll�l �I �IWII�� IIII�� III�IIVIu STATE 5422910 u I BUSINESS LOCATION: 14080 SW 38 ST MIAMI, FL 33175 BUS. COMMENCEMENT DATE: 10/01/2004 OWNER/CORP. STATEWIDE BUILDING CONTRACTOR LLC STATEWIDE BUILDING CONTRACTOR LLC DANIEL GATO PRES 14080 SW 38 ST MIAMI, FL 33175 SEC TYPE OF BUSINESS BLDG1 GENERAL BUILDING CONTRACTOR APPLICATION IS HEREBY MADE FOR A LOCAL BUSINESS TAX RECEIPT OR PERMIT FOR THE BUSINESS PROFESSION OR OCCUPATION DESCRIBED HEREON. I HAVE BEEN INFORMED OF ALL ZONING RESTRICTIONS IMPOSED ON THIS RECEIPT. I SWEAR THAT THE INFORMATION IS TRUE AND CORRECT. SIGNATURE REQUIRED SEE INSTRUCTIONS ABOVE Please pay only one amount. The amounts due after Sept 30th include penalties per FS 205.053. ff Received By Oct 31, 2014 Nov 30, 2014 Dec 31, 2014 Jan 31, 2015 Please Pay $0.00 $0.00 $0.00 $0.00 7000000000000000000000005662698201500000007500000000000009 PnlirvNr rnhwr Date Entered: nc ,j, inm A /�® L•/ CERTIFICATE OF LIABILITY INSURANCE DATE (MM/OD/ 10 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT; If the certificate holder Is an ADDITIONAL INSURED, the pollcypes) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER KEY KNOWLEDGE INSURANCE, INC. 9101-C S. W. 19TH. PLACE FORT LAUDERDALE, FL. 33324 CONTACT NAME: PHONEFAX (954)382-5259 arc No; (954)382-0080 .W. Mlk.,mryals@kepknowledgeins.com INSURER(S) AFFORDING COVERAGE NAIC d INSURER A : Accident Insurance Company INSURED STATEWIDE BUILDING CONTRACTORS, LLC DANIEL GATO 14080 SW 38TH STREET MIAMI,, FL 33175 INSURER B: INSURER C: INSURER D: INSURER E: INSURER F: vTHIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADL INS SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $300.000 PREMISES aa=rrence $100,000 A COMMERCIAL GENERALWIBILITY CLAIMS -MADE X OCCUR CCP -0002841-02 5/17/2014 5/17/2015 MED EXP (Any one person) $5,000 PERSONAL &ADV INJURY $3010,000 GENERAL AGGREGATE $60,01000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $GOO 000 $ POLICY PRO- LOC COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY Ea accident $ BODILY INJURY (Per person) $ ANYAUTO N/A BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTO`' AUTOS ED HIRED AUTOS qAUTOS PROPERT Y DAMAGE $ Per accident) UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE N/A DED I I RETENTION $ $ WORKERS COMPENSATION WCSTATU OTH- I AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETORIPARTNEWEXECUTIVE r--1 N/A E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ OFFICERIMEMBER EXCLUDED? (Mandatory In NH) N/A E.L. DISEASE -POLICY LIMIT $ If yes, describe under DESCRIPTION OF OPERATIONS below N/A DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) GENERAL CONTRACTOR MIAMI SHORES VILLAGE 10050 N.E. 2ND AVENUE MIAMI SHORES, FL. 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rignts reservea. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD Produceduaing Farms Bose Plus software.www.For=Boss.comfmpressWublishtng 800-208-1977 Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner- Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees, including the owner, must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: 1. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC, a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State, Division of Corporations; and 3. The corporation is registered and listed as active with the Florida Department of State, Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption. In these circumstances, Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company. Therefore, y2u may be personally liable for the worker compensation injuries of any_person allowed to work under this permit. Please check with your insurance carrier since most property insurance policies DO NOT cover this type of liability. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Owner Print Name: 3r 4tj Signature: State of Florida ) County of Miami -Dade ) Sworn to and subscribed before me this �D day of Xnf ,Ac , 20 41 By�,�,Lourdes Made Gimena (SEAL) Type of M - Contractor Print Name: Signature: State of Florida) County of Miami -Dade ) Sworn to and subscria this 10 day of 1RH &,ls eF`o, • ''� By ��•... '��� E�(PIRES: MAY3002M7 ET 2 < .0IRA1v�rprAm of Mentification produced rf&ma 11 Ulhn